CDS leads to reduction in CPTA imaging for pulmonary embolism

The use of evidence-based clinical decision support (CDS) results in a significant reduction in CT pulmonary angiographic imaging in patients suspected of having a pulmonary embolism, according to a study published online in Radiology.

According to the researchers from Brigham and Women’s Hospital in Boston, adopting CDS was associated with a 12.3% immediate and sustained decrease in the use of CT pulmonary angiographic examinations in these patients.

The study included 227,374 patients admitted during the study period (April 1, 2007 and June 30, 2012). During that time 5,287 patients underwent 5,892 CT pulmonary angiographic studies and the researchers compared before and after the implementation of a clinical decision support system in October 2009.

In the month before the CDS system was implemented, the use of CT pulmonary angiographic imaging was estimated to be 26.0 examinations per 1,000 admissions, while in the month after the CDS system was implemented use of CT pulmonary angiographic imaging decreased to 22.8 examinations per 1,000 admissions.

This decrease in the frequency of CT pulmonary angiographic imaging examinations was unique to the month after the CDS system was implemented. There was no significant increase or decrease in the use of CT pulmonary angiographic imaging in the study period leading up to CDS implementation, or in the post-implementation period

The percentage of CT pulmonary angiographic examinations positive for acute pulmonary embolism increased from 10.4% in the month before CDS implementation to 12.1% after—a difference the researchers said was “not statistically significant.”

“This decrease in use was sustained over the ensuing 32 months. Imaging CDS and CDS-enabled interventions may provide an effective strategy to reduce waste, improve quality of care, and reduce unnecessary radiation exposure for hospitalized patients,” the authors concluded.